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Clinicopathological Concordance in Panniculitis: A Prospective Study of 48 Cases
Piyush Yadav1, Prashant Durgapal2, Naveen Kumar Kansal1
1Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India.
Background:
Retrospective studies suggest that clinicopathologic concordance rates in panniculitis vary significantly, leading to potential misdiagnoses, delayed treatments, and suboptimal patient outcomes. However, prospective data systematically evaluating the concordance between clinical impressions and histopathologic findings in panniculitis is lacking. This study aimed to determine the concordance between the clinical and histopathological diagnoses in cases with clinical suspicion of panniculitis.
Methods:
In this prospectively conducted cross-sectional study at a tertiary-care center in North India, patients' clinical data were recorded, and a deep skin biopsy was performed. Histopathological slides were evaluated for panniculitis features such as the septal or lobular pattern of involvement, presence of vasculitis, type of infiltrates, and fat necrosis.
Results:
Most cases (71%) were diagnosed with erythema nodosum leprosum (ENL) based on clinical evaluation and a predominantly lobular pattern of panniculitis (73%) based on histopathological evaluation. We reached a single clinical diagnosis in 41 cases (85%), while the remaining cases had more than one clinical diagnosis. Overall, there was a 69% concordance between clinical and histopathological findings.
Conclusion:
This study underscores the importance of integrating clinical and histopathological data for an accurate diagnosis of panniculitis rather than relying solely on one or the other.
Insights
Accurate panniculitis diagnosis requires integrating clinical and histopathological findings. This study found only 69% concordance, highlighting the need for combined approaches to improve patient outcomes and avoid misdiagnosis.
Area of Science:
- Dermatology
- Pathology
Background:
- Retrospective studies show variable clinicopathologic concordance in panniculitis.
- Lack of prospective data on clinical vs. histopathological diagnosis concordance.
- Potential for misdiagnosis, delayed treatment, and poor outcomes in panniculitis.
Purpose of the Study:
- To determine the concordance between clinical and histopathological diagnoses in suspected panniculitis cases.
- To evaluate the accuracy of clinical assessment against histopathological findings in panniculitis.
Main Methods:
- Prospective, cross-sectional study at a tertiary-care center in North India.
- Deep skin biopsy and histopathological evaluation for panniculitis features (septal/lobular, vasculitis, infiltrates, fat necrosis).
- Clinical data collection and diagnosis recording.
Main Results:
- Erythema nodosum leprosum (ENL) was the most common clinical diagnosis (71%).
- Predominantly lobular panniculitis was the most common histopathological finding (73%).
- Overall concordance between clinical and histopathological diagnoses was 69%.
Conclusions:
- Highlights the importance of integrating both clinical and histopathological data for accurate panniculitis diagnosis.
- Sole reliance on either clinical or histopathological data may lead to diagnostic inaccuracies.
- Combined diagnostic approach is crucial for optimal patient management in panniculitis.
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